gms | German Medical Science

Objective: Prophylactic antiplatelet medication is beneficial in decreasing thromboembolic complications during endovascular treatment for unruptured intracranial aneurysms. The efficacy may be limited by individual response variability to antiplatelet medication, especially to clopidogrel (CPG). We compared the efficacy of two antiplatelet medications, low-dose prasugrgical (PSG) and CPG, in patients undergoing endovascular treatment for unruptured aneurysms.

Method: From November 2014 to July 2015, 194 patients harboring 222 unruptured aneurysms underwent endovascular treatment at a single institution. Laboratory and clinical data from the prospectively maintained registry were utilized. Antiplatelet medication was given the day before endovascular treatment (PSG 20 mg or 30 mg, CPG 300 mg). Response to the antiplatelet medication was measured by the VerifyNow system. Periprocedural adverse event rates were compared between the two groups.

Results: There were no significant differences in the baseline characteristics of patients and aneurysms between the two groups. The P2Y12 reaction units (PRU) values were lower (242.7 ± 69.8 vs. 125.7 ± 79.4; P < .0001) and percentage inhibition values were higher (22.1 ± 19.7 % vs. 60.2 ± 24.7 %; P < .0001) in the PSG group. There was no thromboembolic events, but there was 1 procedural bleed in each group, without any clinical consequences.

Conclusions: Our data demonstrated the superiority of the low-dose PSG premedication, which showed consistent suppression of platelet reactivity. We may omit the antiplatelet response assay with the low-dose PSG premedication prior to the endovascular treatment of unruptured-aneurysm patients.